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Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy - Three-month results from a randomized study

Item Type:Article
Title:Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy - Three-month results from a randomized study
Creators Name:Felix, S.B. and Staudt, A. and Doerffel, W.V. and Stangl, V. and Merkel, K. and Pohl, M. and Doecke, W.D. and Morgera, S. and Neumayer, H.H. and Wernecke, K.D. and Wallukat, G. and Stangl, K. and Baumann, G.
Abstract:Objectives. The objective of our study was to assess the hemodynamic effects of immunoadsorption (IA) and subsequent immunoglobulin G (IgG) substitution in comparison with the effects of conventional medical treatment in patients with dilated cardiomyopathy (DCM). Background. Various circulating cardiac autoantibodies have been detected among patients suffering from DCM. These antibodies are extractable by IA. Methods. Patients with DCM (n = 18, New York Heart Association III-IV, left ventricular ejection fraction <30%) and who were on stable medication participated in the study. Hemodynamic measurements were performed using a Swan-Ganz thermodilution catheter. The patients were randomly assigned either to the treatment group with IA and subsequent IgG substitution (IA/IgG group, n = 9) or to the control group without IA/IgG (n = 9). In the IA/IgG group, the patients were initially treated in one IA session daily on three consecutive days. After the final IA session, 0.5 g/kg of polyclonal IgG was substituted. At one-month intervals, IA was then repeated for three further courses with one IA session daily on two consecutive days, until the third month. Results. After the first IA course and IgG substitution, cardiac index (CI) increased from 2.1 (±0.1) to 2.8 (±0.1) L/min/m 2 (p < 0.01) and stroke volume index (SVI) increased from 27.8 (±2.3) to 36.2 (±2.5) ml/m 2 (p < 0.01). Systemic vascular resistance (SVR) decreased from 1,428 (±74) to 997 (±55) dyne·s·cm -5 (p < 0.01). The improvement in CI, SVI and SVR persisted after three months. In contrast, hemodynamics did not change throughout the three months in the control group. Conclusions. Immunoadsorption and subsequent IgG substitution improves cardiovascular function in DCM.
Keywords:Autoantibodies, Dilated Cardiomyopathy, Hemodynamic Processes, Immunoglobulin G, Immunosorbent Techniques, Left Ventricular Function, Myocardium, Stroke Volume
Source:Journal of the American College of Cardiology
ISSN:0735-1097
Publisher:Elsevier (U.S.A.)
Volume:35
Number:6
Page Range:1590-1598
Date:1 May 2000
Official Publication:https://doi.org/10.1016/S0735-1097(00)00568-4
PubMed:View item in PubMed

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